Frostbite And Other Localized Coldrelated Injuries

Mark B. Rabold Pathophysiology

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Throughout history the most celebrated and extreme reports of cold-related injuries have been in the field of military endeavor. From Hannibal's losing half his 46,000-man army crossing the Pyrenean Alps to frostbite and hypothermia, to the tens of thousands of cases of trench foot during World War I, we have learned much. Perhaps the most famous cold-injury mass-casualty incident was Napoleon's retreat from Moscow during the dreadful winter of 1812-1813. This first authoritative account, as described by Napoleon's surgeon-in-chief, Baron de Larrey, described how each evening thousands of French soldiers thawed, and often inadvertently burned, their frozen extremities over campfires, only to refreeze them again on the next day's march. Combined heat and cold injury coupled with refreezing and forced ambulation resulted in abysmal outcomes. In addition, thousands died from the tetanus sustained from their frostbite wounds. It was from this experience that Larrey recommended rubbing frostbitten extremities with snow. This destructive therapy was the standard of care until the 1950s and is still used occasionally by the lay public. It was not until 1956 that rapid rewarming of frozen extremities was studied by a Public Health Service medical officer in Tanana, Alaska, which laid the foundation of modern therapy.1

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